| Southern Magnolia Therapeutic Solutions | |
|
4347 S Hampton Rd # 243 Dallas TX 75232-1065 | |
| (214) 289-0456 | |
| Not Available |
| Full Name | Southern Magnolia Therapeutic Solutions |
|---|---|
| Speciality | Case Management |
| Location | 4347 S Hampton Rd # 243, Dallas, Texas |
| Authorized Official Name and Position | Kendra Williams (OWNER/CHEF EXECTIVE OFFICER) |
| Authorized Official Contact | 2142890456 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Magnolia Therapeutic Solutions Po Box 763773 Dallas TX 75376-3773 Ph: (214) 289-0456 | Southern Magnolia Therapeutic Solutions 4347 S Hampton Rd # 243 Dallas TX 75232-1065 Ph: (214) 289-0456 |
| NPI Number | 1184484032 |
|---|---|
| Provider Enumeration Date | 03/19/2024 |
| Last Update Date | 05/21/2024 |
| Certification Date | 05/20/2024 |
| Medicare PECOS PAC ID | 7911440383 |
|---|---|
| Medicare Enrollment ID | O20240614000067 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184484032 | NPI | - | NPPES |
| Provider Name | Tricia Davis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447561394 PECOS PAC ID: 3577840404 Enrollment ID: I20170503000008 |
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